Gestational diabetes is a common condition that can impact your pregnancy and the health of your baby. To learn more about gestational diabetes, the screening process, and what to do if you're diagnosed, read on!
Near the end of your second trimester, typically between 24 to 28 weeks, your doctor will have you take a standard but crucial test: the glucose test.
The glucose test checks for gestational diabetes, which can be a very serious condition that hurts both you and the baby if left untreated. Luckily, it's relatively easy to manage with timely treatment. So, it's important to get tested.
Before you head off to your appointment, here’s what you should know about gestational diabetes testing, including alternative testing options, and how to help your body manage the condition if you're diagnosed.
What Is Gestational Diabetes?
Gestational diabetes is a condition when a pregnant woman's body fails to regulate blood sugar levels efficiently, and they simply become too high. Nearly 2% to 10% of pregnant women develop this condition.
If you are diagnosed, you'll be in one of two classes: Class A1 and Class A2. Class A1 patients can control the condition through diet and exercise alone, while Class A2 gestational diabetes patients might need to administer insulin or oral medications to keep their blood glucose in check.
While this is typically a temporary condition (good news!), it is still crucial to treat it and understand possible complications of it.
What Causes Gestational Diabetes?
Physiologically speaking, the cause of gestational diabetes is largely related to the placenta, but the overall cause remains largely unknown. When you are around 20 weeks pregnant, the placenta produces hormones such as cortisol, estrogen, and human placental lactogen. Doctors explain that these hormones can cause insulin resistance, allowing glucose to build up in your body.
Typically, the pancreas releases insulin to move the glucose along and help the body use it as energy. However, as the placenta grows, more hormones are produced.
As you might guess, the risk of insulin resistance can also increase. Sometimes the body cannot keep up to create enough insulin to overcome the insulin resistance brought on by these new placental hormones, resulting in uncontrolled, high blood sugar levels. This process causes you to get gestational diabetes.
Genetics & Health History
Your genetics and health history contribute to your risk factor for getting gestational diabetes.
- You are overweight. When you have a body mass index (BMI) of 30 or more while being pregnant, you’re at the most risk of developing gestational diabetes. The extra weight can harm your insulin’s ability to regulate your blood sugar levels effectively.
- You are over the age of 35. Doctors have found that older women, typically over the age of 35 years, show a significantly higher tendency of developing gestational diabetes.
- You received a pre-diabetes diagnosis. If your blood sugar levels are already higher before pregnancy, the risks of gestational diabetes are high.
- You have a family history. If your family members suffer or have suffered from diabetes, you are naturally at a higher risk. Additionally, if you had gestational diabetes during a previous pregnancy, you're more likely to have it again in the next pregnancy.
- You have been put on bed rest. Being put on bed rest means you’re going to be inactive most of the time. As a result, you’ll end up putting on more pregnancy weight and more likely to develop gestational diabetes.
- You have a higher level of abdominal fat. The American Diabetes Association published in the journal Diabetes Care that women with higher levels of tummy fat during the first trimester of pregnancy are more likely to develop gestational diabetes.
When Should You Get Tested?
While it’s recommended to test between 24 and 28 weeks of pregnancy, expecting mothers who have a history of diabetes in the family or have been diagnosed as prediabetic in the past should get it done sooner.
Your doctor might also recommend testing earlier if you have a high glucose level in your urine during any of your routine prenatal visits.
Complications of Untreated Gestational Diabetes
You have to take the necessary measures to keep gestational diabetes under control as it does come with some potentially serious complications:
- Premature birth
- High blood pressure or preeclampsia
- Shoulder dystocia, a condition where the baby’s shoulders get stuck in the birth canal during delivery
- Slightly higher rates of fetal and neonatal deaths
- High birth weight, also known as fetal macrosomia. The problem with macrosomia is that it may result in shoulder damage during birth and increase the chances of cesarean delivery. Additionally, babies with macrosomia are at a higher risk of childhood obesity and type 2 diabetes.
The Gestational Diabetes Test
It's super important to get the gestational diabetes test because many women don't have any symptoms of the condition. There are two types of glucose tests. Blood tests are the most reliable way to diagnose gestational diabetes.
There are two methods of screening.
The Two-Step Method
This is the most common test and will measure how well your body produces insulin. And, as the name suggests, this testing method involves two steps:
Step 1: The One-Hour Glucose Tolerance Test
For the first step, you drink a glucose drink that contains 50g of glucose.
One hour after consuming the drink, you’ll have your blood drawn for testing. If the blood sugar is above the cut-off, typically 140 mg/dL, you’ll have to proceed to the next step.
Step 2: The Three-Hour Glucose Tolerance Test
In step 2, you’ll have to fast for 8 to 14 hours before taking the test. For this test, you’ll have to drink another drink, which is even sweeter (!) and will contain 100g of glucose. In this case, your blood sugar will be tested three times after consuming the glucose drink: after one hour, two hours, and three hours.
Test Result Interpretation
As mentioned before, to pass the first step, your blood glucose has to be less than 140 mg/dL.
Please remember that failing step 1 does not mean you have gestational diabetes. In fact, according to research, only one out of three women who fail the first step are diagnosed with gestational diabetes.
For step 2, however, things are a bit more detailed. The following are signs that indicate gestational diabetes:
- While fasting, your blood glucose is greater than 95 mg/dL.
- One hour after consuming the glucose drink, your blood glucose is greater than 180 mg/dL.
- Two hours after consuming the glucose drink, your blood glucose is greater than 155 mg/dL.
- Three hours of consuming the glucose drink, your blood glucose is greater than 140 mg/dL.
A gestational diabetes diagnosis will ultimately be given if two or more of your blood values for the three-hour test exceeds the thresholds mentioned above. That said, some doctors do diagnose gestational diabetes if only one of your blood values exceeds the threshold.
The One-Step Method: The Two-Hour Glucose Tolerance Test
As you might guess, this particular test is a shortened version of the two-step test. This type of testing is not done very commonly anymore.
In order to get an accurate result, your doctor will ask you to fast for 8 to 14 hours before taking the test. This means no food and no drinks except for water! At your test, you will drink a sweet glucose drink that contains 75g of glucose.
Your blood sugar will be tested before you consume the drink and then twice after drinking it – one test after an hour of drinking the glucose drink and another after two hours.
Test Result Interpretation
You’ll be diagnosed with gestational diabetes if your blood values reach certain thresholds:
While fasting, your blood glucose is greater than 92 mg/dL.
Your blood glucose is greater than 180 mg/dL one hour after consuming the glucose drink.
Your blood glucose is greater than 153 mg/dL two hours after consuming the glucose drink.
Note that the two-hour one-step test does have a marginally higher rate of gestational diabetes diagnosis because the criteria and thresholds are slightly different. That said, the ACOG supports the more commonly used, two-step test over the one-step test.
Useful Tips for the Gestational Diabetes Test
There is no passing or failing your glucose tolerance test. If you find out that you're diabetic, you have to get the required treatment to prevent complications for your baby and yourself. And if you’re not, then great! You aren't a diabetic.
So, don't cheat the system. It's in your and your baby's best interest to get an exact result. I have a few tips to help you make sure your results are accurate.
No Cheat Meals While Fasting
This is actually an incredibly important factor. Having a midnight snack or a few bits of breakfast may not seem like a big deal, but it can impact your test result. Stick to the rules!
Avoid False-Positive Results
The one thing you will want to do is consider what not to eat prior to testing as a way to avoid a false-positive result. This includes foods that are simple carbohydrates with higher amounts of sugar like white bread, bagels, fruit smoothies, donuts and pastries, cakes, cookies, muffins, candy, soda.
Opt for an Early Morning Appointment
The easiest time to make your appointment is first thing in the morning. That way, the bulk of your fasting time will be during sleeping hours. You can wake up and go directly to your appointment and then resume your day with normal eating.
Hydrate, Hydrate, Hydrate!
While fasting, one thing that you can do is have small sips of water throughout. Always stay hydrated when pregnant!
Staying Busy and Staying Active
Try to keep yourself occupied by reading a book, listening to music, or anything that keeps you busy. Three hours can be a long time, so bring some entertainment and relax!
Quick Tip: You‘re probably going to want to eat right after your test, so bring a snack in your purse and plan to get a balanced meal afterward.
Understanding the Warning Signs of Gestational Diabetes
Women usually develop gestational diabetes during the second trimester, which is around the 24th week, but that's not always the case. Understandably, the sooner the condition gets flagged, the better. Sometimes, gestational diabetes can remain undetected for weeks since the warning signs tend to overlap with the general pregnancy symptoms.
The early signs of gestational diabetes include:
- Extreme fatigue and lethargy
- Unusually strong cravings for sweet drinks and food items
- Frequent urge to urinate
- Extreme nausea and even vomiting after eating
- Dry mouth and constant feelings of thirst
- Blurred vision
- Tingling sensations in the hands or feet
What to Do if You Are Diagnosed With Gestational Diabetes
If you’ve been diagnosed with gestational diabetes, there is no need to worry. You can still have a healthy pregnancy, but you'll want to make some healthy changes to your lifestyle to keep your gestational diabetes under control.
Regular physical activity – both during and after pregnancy – can help lower your blood sugar, along with relieving common discomforts of pregnancy, such as back pain, swelling, constipation, muscle cramps, and insomnia.
I would also recommend speaking to your doctor about the exercises that are (and aren’t) good for you during this time. Generally, exercising for 30 minutes a day and strength training two to three times per week is an excellent place to start.
Regular Weight Monitoring
The weight that you should gain during pregnancy depends on your pre-pregnancy weight. ACOG recommends women who have a normal, healthy weight gain 25-35 pounds during pregnancy, while overweight women (25-29.9 BMI) should gain 15-25 pounds. Obese women who have 30 BMI or higher should try to gain 11-20 pounds only.
Decreasing Carb Intake
Carbohydrates convert to sugar, which ends up boosting your blood sugar. It’s not necessary for you to cut out all carbs, but instead, adopt a more cautious approach of moderate consumption and spreading them across your day.
In my opinion, enlisting the services of a registered dietician and nutritionist could be very helpful. This person should have the experience and expertise to help you develop a meal plan specifically tailored to your condition.
Taking Insulin or Medication (If Necessary)
Monitoring your blood glucose levels needs to be a part of your daily life. If you find that diet and exercise alone aren’t enough to control those levels properly, you might need to take insulin.
In some cases, your doctor might recommend alternative medications, but insulin is typically the first choice. Doctors often prescribe metformin for those who aren’t comfortable taking insulin or giving themselves injections.
Get Tested & Good Luck!
I hope all this information will help you put your mind at ease and help you prepare for your gestational diabetes test. Remember, practice healthy lifestyle choices: exercise, eat healthy, hydrate, and surround yourself with supportive friends and family. With this, you'll be able to approach any diagnosis with confidence knowing you are doing all you can to keep you and your baby healthy. Good luck!
Did you have gestational diabetes? What did you do to stay healthy during your pregnancy? I'd love to hear!